Chronic pain syndromes and their associated management have dominated the medical landscape for the past three decades. While great progress has been made in chronic pain management, there is no outstanding drug that reliably relieves chronic pain without unacceptable complications and/or adverse effects. This is particularly true in the management of chronic musculoskeletal pain syndromes.
Musculoskeletal pain and myofascial pain are very common in most societies and in most countries. These pains are derived usually from traumatic injuries, inflammatory lesions, various arthritic processes, postural, athletic and occupational events and in older persons, a simple consequence of the degenerative aging process. Whereas all pain regardless of etiology is unpleasant and is usually associated with negative perceptions and emotions, pain, especially chronic pain, should never be considered benign. The pain associated with progressive pancreatic cancer or metastatic lung or breast cancer, for example, may be appropriately labelled as malignant pain because these pains may be associated with death and the dying process. The pain of non-neoplastic musculoskeletal lesions, however, should not be labelled as benign: a characterization of non-malignant chronic pain is more appropriate.
The treatment of non-malignant, chronic musculoskeletal pain may be holistic and conservative; interventional; or pharmacological. The holistic or conservative measures include exercise, diet management, physical therapy, coordinated chiropractic measures, acupuncture and appropriate complementary non-invasive measures. The interventional measures used to treat non-malignant, chronic musculoskeletal pain should be few and seldom needed or used. Occasionally, selected peripheral nerve blocks may be indicated but major procedures or surgical interventions are seldom warranted.
The pharmacological treatment of non-malignant, chronic musculoskeletal pain involves the use of topical analgesic agents and oral analgesic adjuvants including non-steroidal anti-inflammatory drugs, COX-2 inhibitors, gabapentinoids, narcotic analgesics, and other drugs. All these drugs have potential side effects and complications. Acetaminophen, which is commonly used for musculoskeletal pain, may cause irreversible hepatic disease in some patients and only recently was shown to be associated with ADHD (Attention Deficit Hyperactive Disorder) in the children of patients who took that drug during gestation. See, Benson, G D. Clin Pharmacol Ther. 33:95-101 (1983) and Liew et al., Jama. Pediatr. 168(4): 313-320 (2014), each incorporated by reference with regard to the noted teaching. Non-steroidal anti-inflammatory drugs (NSAIDS) gained popularity, but the resultant gastrointestinal complications associated with costly hospitalization and even death have curtailed their use. See, Fitzgerald G A, New Engl J Med. 351:1709-1711 (2004). Furberg et al., Circulation. 111:249 (2005), incorporated by reference with regard to the noted teaching. Hepatic and renal complications may also occur with use of known analgesic drugs. See, Cheng et al., Hypertension. 43:525-530 (2004), incorporated by reference with regard to the noted teaching.
In recent times, the consequences of inappropriate use of narcotic analgesic drugs have become so serious in the US that both state and federal governments are taking active and definitive measures to deal with those issues which are assuming national importance. Drug addiction, habituation, dependency, drug abuse, drug misuse, drug diversion, and drug overdose are all too common and the resulting challenges are becoming major national, social, legal, cultural and economic issues of this decade. See, e.g., Trescot et al., Pain Physician. 9:1-40 (2006) and Manchikanti et al., Pain Physician. 9:215-225 (2006), incorporated by reference with regard to the noted teaching. The risk to all socioeconomic segments of society dying from the complications of opioid abuse and misuse is alarming. In many instances, these persons initially began using opioids for relatively trivial musculoskeletal or myofascial lesions and then progressed to more potent drugs and larger doses. See, e.g., Compton et al., Drug Alcohol Depend. 83(suppl. 1):S4-S7(2006), incorporated by reference with regard to the noted teaching. Further, opioids may also cause early and late respiratory depression, constipation, pruritus, and urinary retention. See, e.g., Pasternak G W. J Pain Symptom Manage. 29(5 suppl):S2-S9 (2005), incorporated by reference with regard to the noted teaching.
In St. Lucia, the Caribbean, and many other parts of the world, it has been well-known that coconut oil has many dietary, therapeutic, and analgesic properties. Whereas, there is very scant scientific evidence to support those claims, most indigenous inhabitants of those tropical and subtropical countries embrace and practice that belief. Thus, a novel composition including essential oils, like coconut oil, which has both analgesic and anti-inflammatory properties without harmful side effects, could prove to be efficacious as a topical analgesic in the management of chronic musculoskeletal and myofascial pain. Such a composition is currently commercially available in St. Lucia and sold as “Fidapin”.